Innermost Healthcare offer a range of services for pregnant women who wish to have individual tests and checks for additional reassurance including those not available from the NHS as well as those who want the whole package of private antenatal care. We also offer private parentcraft classes and a wide range of holistic services such as women’s and obstetric physiotherapy including the Mummy MOT, pregnancy exercise, acupuncture, psychotherapy and counselling and nutritional therapy.

SECOND TRIMESTER (14-26 weeks)

During the second trimester most of the troublesome symptoms such as tiredness, nausea and vomiting improve.

The miscarriage risk is substantially reduced to less than 1% and fetal movements will be felt from 16-18 weeks, providing daily reassurance of that the baby is alive and active. The heartbeat can be heard by hand held Doppler devices and midwives will often use these at routine antenatal checks to listen to the baby’s heartbeat. Some pregnant and their partners may wish to buy their own Doppler device but this should only be used for bonding purposes to listen to their baby’s heartbeat and not to check on the baby, especially if they are worried about changes in the baby’s pattern of movements or any other concerns about the welfare of the baby. Click to here to read about the Unbornheart Smartphone Fetal Doppler.

Pregnancy is usually divided into three Trimesters each lasting about 13 weeks.

Click on our Pregnancy Timeline to see an overview of all the different tests that may be considered during each of these three stages of pregnancy.

Fetal Growth, Measuring the Bump (S-F height)

Traditional antenatal care in the second trimester is based on measuring the bump (symphysis – fundal height) and detects about 30% of babies who are not growing properly. Plotting the growth measurements on a customised chart (GROW) by trained midwives in a highly structured way (GAP Programme) will improve this to about 50%. This will still miss about half of those babies who are growth restricted and also at increased risk of stillbirth.

Growth Scans (14-24 weeks)

Growth scans however will assess not only fetal size but also other aspects of fetal wellbeing such as the amniotic fluid volume and the blood flow through the placenta (umbilical artery doppler). Serial scans also allow the chance to follow the rate of growth (growth velocity) as this is more important than just measuring size alone. A small baby that is growing normally should be healthy whereas a big baby whose growth has slowed may be in difficulties and at risk. Babies who are significantly compromised or at risk of stillbirth may need close surveillance and possibly early delivery.

Gender Scans

Whilst many pregnant women and their partners may choose to wait until the baby is born, others may wish to find out the gender of their unborn baby. This can be seen from about 16 weeks based on a transabdominal scan with an accuracy of over 90%. NIPT is however much more accurate.

Anomaly Scan (20 weeks)

This transbdominal scan can detect about 70% of major structural abnormalities, a low lying placenta (placenta praevia) and rarely a blood vessel which overlies the placenta (vasa praevia) which can cause lethal bleeding in labour. In the UK the RCOG have identified specific views and structures which should be checked at NHS Anomaly Scans but screening for vasa praevia is not included. Some support groups feel this should be universally offered.

The Anomaly Scan will identify about 99% of babies with conditions like spina bifida, about 50% of babies with major heart defects but only a few babies with bone growth problems (skeletal dysplasias). It cannot detect cerebral palsy, autism and learning problems.

Cardiac Scan or Fetal Echo (24 weeks)

Serious cardiac defects are present in about 1 in 100 newborn babies (1%).

Up to 50% are missed antenatally and one the newborn examination before discharge from hospital and some babies deteriorate rapidly at home to be readmitted as an emergency when resuscitation may be too late.

Antenatal detection is thus important as it allows proper planning of place of delivery and initial medical treatment for the baby which may also require urgent surgery.

At 24 weeks a detailed cardiac scan will identify about 90% or more babies with cardiac defects allowing optimal planning of the baby’s care after delivery.

Screening for Pre-eclampsia

Pre-eclampsia is a condition in which pregnant women develop high blood pressure (hypertension) often associated with swelling especially in the ankles (oedema) and protein in the urine (proteinuria). There is no cure for it but it can be managed and this may require early delivery. It can lead to maternal fits (eclampsia), stroke and liver and kidney damage in the woman and growth restriction and stillbirth in the baby. Routine antenatal care therefore includes regular scheduled checks on blood pressure and urine testing with dipsticks which can identify protein in the urine to identify pre-eclampsia. Since the condition is more common in first pregnancies the schedule is more regular but it may occur earlier than expected or in between routine checks and therefore more frequent checks may be appropriate in some pregnancies. The condition also affects placental blood flow and so regular ultrasound assessment of fetal wellbeing may be appropriate.

Uterine Artery Doppler Scan (20 to 24 weeks)

An ultrasound scan at 20-24 weeks (Uterine Artery Doppler) can identify those pregnancies at increased risk of both pre-eclampsia and poor placental function and growth restriction so that more frequent checks can be made on the woman and closer monitoring of her baby. At 24 weeks this can also be combined with a baseline growth scan to check on the baby’s current condition and size.

Flu (Influenza) Vaccination

Influenza in pregnancy can cause a serious life threatening illness in the mother which may require termination or early delivery of the baby and thus flu vaccination is offered to pregnant women to reduce the risk of developing this infection.

Pertussis (Whooping Cough) Vaccination

Whooping cough can cause serious infections in newborn and young babies before they are old enough to be vaccinated. All pregnant women are therefore advised to consider being vaccinated any time from 16 weeks. The antibodies that are produced by the pregnant woman will cross the afterbirth (placenta) and protect the baby from the moment it is born until it is old enough to be vaccinated.

Preterm Birth and Cervical Incompetence

Preterm birth is a major cause of death and handicap in newborn babies affecting 6-8% of pregnancies. Some pregnancies are recognised as being at increased risk such as those who have had a previous very preterm birth (<32 weeks gestation), cervical surgery (eg. cervical cone biopsy), suspected cervical incompetence or multiple pregnancies. In many cases there are no warning signs. Cervical Incompetence Scan (16+ weeks). A transvaginal ultrasound scan (Cervical Incompetence Scan) can assess the cervix to identify pregnancies at increased risk of preterm delivery based on: • Length of the cervix (normally >25mm)

• Funneling of the membranes at the internal os.

• Dilatation of the cervix

• Location of a cervical suture (if present)

Fetal Fibronectin Test (22 to 25 weeks): Another useful way to predict preterm birth is based on a vaginal swab test to identify a substance called fetal fibronectin. The results are available in about 20 minutes. A negative result means that there is over a 99% reassurance that the woman would not go into labour in the next two weeks. This is particularly useful for those going on international holidays or whose partners are travelling or away during the pregnancy. A positive result indicates a high risk of early delivery.

An abnormal Cervical Incompetence scan or a positive Fetal Fibronectin Test allows various interventions to be discussed such as a cervical stitch (cervical cerclage), drugs to relax the uterus and steroids to reduce breathing difficulties (Respiratory Distress Syndrome) in the baby if it is born early.

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